Making Mental Health Support as Accessible as a Text Message with Johnny Crowder, Founder and CEO of Cope Notes

[00:00:04] [SPEAKER_00] Hello everyone and welcome back to the Outcomes Rocket podcast. Hope you all are having an awesome day today. It's about to get better because I've got Johnny Crowder with us. He is the CEO of Cope Notes based in Tampa, Florida.

[00:00:26] [SPEAKER_00] He's a mental health advocate who speaks openly about living with bipolar disorder, OCD and psychosis and about surviving abuse and suicidal ideation. He's been a NAMI trained speaker and holds peer specialist credentials. He's done TEDx talks and just talking to corporations as well as small groups around the critical issue of mental health.

[00:00:56] [SPEAKER_00] So I'm really excited to have him here on the podcast. Johnny, thanks for being with us, man. Yeah, dude. This is my favorite thing in the world is advocacy. Well, you're doing a beautiful job. Tell us your story, man. Like what got you to where you're at today and what keeps you here?

[00:01:15] [SPEAKER_01] Yeah, I joke like, you know, Tupac is famous for saying like, I didn't choose the thug life. The thug life chose me. And like when I was growing up, I wanted to be a rock star. So I did not. I didn't dream of becoming like a mental health advocate. No way. But do you play music? Oh, yeah. What do you play? Huge part of my life. I play guitar and sing. Oh, you do? Yes, sir. I want to learn, actually. I want to learn how to play. Dude, talk about a healthy coping mechanism. It's just like therapeutic, right?

[00:01:44] [SPEAKER_01] That was like my whole plan was like, I'm just going to do music. And then really, I started struggling really, really significantly with severe mental illness. And so I went to treatment in high school. I'm skipping a lot of details. Went to treatment in high school, went to college and got a psych degree and started working in behavioral health and became really passionate about like how to leverage what I have been through to help other people.

[00:02:08] [SPEAKER_01] So now the thing that keeps me coming back, like not only being in therapy for myself to like learn and grow and improve, but also I'm trying to take what I'm learning like either in school or in the trainings that I do or conversations with other behavioral health professionals.

[00:02:27] [SPEAKER_01] And I'm trying to like distill that down into bite-sized pieces and then deliver them to as many people as possible. So sometimes that's being on stage and talking for an hour at a conference. And sometimes it's like sending people text messages through Coke notes that train the brain to think differently. But really, it's like I needed support so badly. And then I got that support. And then now I try to pay that forward in as many different ways as I can.

[00:02:51] [SPEAKER_00] I love it. I think that's great, man. And I think we need a network of solutions and simplicity is key. And we'll unpack text message versus an app, which is what everybody's doing and all those things. Talk to me about Cope Notes. What do you guys do?

[00:03:11] [SPEAKER_01] It's one text per day at a random time that we'll send to your phone. And you never know when we will text you or what the text will say. But you do know that that message contains health education content. So like you might get a psychology fact. I might get a journaling prompt. Someone else might get an exercise. And each message is just a couple sentences long. It's written by a real peer with firsthand lived experience overcoming mental health conditions.

[00:03:36] [SPEAKER_01] Reviewed by clinicians based on proven psychology, but written in plain English. So all you have to do is read these messages when they pop up on your phone. You can journal back if you want to, but you don't have to. And over time, these messages train your brain to combat stress, anxiety and depression in like 10 seconds per day.

[00:03:55] [SPEAKER_00] Man. And so it comes in as a text, which makes it really accessible. You don't have to open anything up. You don't need Wi-Fi.

[00:04:03] [SPEAKER_01] Yeah, dude, you don't even need a smartphone, which is really cool. Like a lot of people don't know this, but there are like tens of millions of Americans who use non-smart cell phones. So like maybe you and I might have an iPhone or something or an Android, but many, many people have phones that can't even download apps. So when we set out to build this, we were like, we want to make it accessible for people without internet, without a data plan, without a smartphone.

[00:04:26] [SPEAKER_01] Even if you have one of those texting plans that you have to pay per text, which that's not super common these days. But even if you did, we use a toll free number. So you don't even have to pay to text us or receive our messages.

[00:04:38] [SPEAKER_00] That's awesome, dude. You know, that's really thoughtful because folks are in different places in life and you don't know where someone might be. And so I think that's really fantastic. So you decided to go text messages. What has that costed you? Meaning like not being on an app?

[00:04:58] [SPEAKER_01] Well, first of all, it is more expensive. So I will say that like we spend more money to deliver text messages than app notifications. And this was like a really strategic bet because, oh yeah, dude, for us, like what we wanted to optimize for was efficacy. So like I don't mind paying more if it works better. And what we found is that when we're doing research on the read rate of text messages versus app notifications,

[00:05:26] [SPEAKER_01] I'm not exaggerating, it is 50 times more likely that you will read a text message than an app notification. So when we were crunching the numbers, we're like, this might cost us more, but if the product works better and helps people more, then it's worth spending the extra money. I'd rather make less profit doing something that makes the world better than make more profit on a product that works less well.

[00:05:52] [SPEAKER_00] Yeah. Yeah. Vaporware. There's too much vaporware out there. Yeah. You know, I was had a chance to chat with Christopher over at Sober Sidekick. I don't know if you know. Yeah, dude. Oh, he's a good buddy of mine. Yes. Great guy. And they went to text route too, you know, and the response rates high. Yep. I believe it. So love that. You know, the business that we're in sort of like the way health care gets delivered in this country

[00:06:20] [SPEAKER_00] is multi-layered. So you've got the payers, which are employers, the government. I call them processors because the processors, the insurance companies, at the end of the day, benefits leaders, right? Like how do you prove to them that a daily text moved anything?

[00:06:40] [SPEAKER_01] I won't say the name of the employer, but we signed a contract with a very large employer for employee wellness. And they signed like a multi-year agreement with us. And then three months in, we get this message from one of their reps that's like, hey, we're thinking about pulling out of the contract because we want to make room for another benefit. And we're just going to gut whatever our most recent benefits are to make room for them. And they had just signed with us.

[00:07:05] [SPEAKER_01] And I was like, okay, this is my cue to like make a case for why Coke Notes is worth keeping. Now, normally we have like, we're having that conversation around the one year, two year, three year mark when we had an opportunity to really work with them. But this was after three months. So we're like, oh crap.

[00:07:21] [SPEAKER_01] So we run this outcome survey. And we deliver a survey and we analyze all the responses from all of their employees. And we turn in this report that says like, hey, just so you know, in less than three months, 80% of your employees have used Coke Notes at least one time, which is if you knew the size of the organization, you'd be like, there's no freaking way.

[00:07:41] [SPEAKER_01] So like four out of five of the employees have used it at least once. And like 25% of your employees are using it every single day on average. So this is like, not only can we show the engagement, this is blowing EAPs out of the water. This is blowing other resources out of the water in terms of engagement. But the other thing that we show is like, here's the quantitative data showing self-reported employees saying they feel more focused, they feel more productive, they feel more connected, they feel less anxious, they feel less stressed,

[00:08:11] [SPEAKER_01] they feel less depressed. And then we give them anonymized testimonials from their employees so they can read word for word. This is what your employees are saying about their experience. And like we still saw we might lose that deal. Like, I don't know. I'm still waiting to hear back. But I'll tell you this. It's really tough to drop a benefit when you're faced with, wow, so many people are using it. So many people are reporting outcomes. And then these are the real sentences that our employees are saying about their experience.

[00:08:41] [SPEAKER_00] I love that. Well, I hope you keep that deal. And I hope they see what people are replying and the numbers.

[00:08:50] [SPEAKER_01] Dude, but that's part of like, unfortunately, I think it's part of being in the mental health category is like when employers are looking to cut, a lot of times they view mental health as like sort of a tertiary, like, yeah, if we have some extra money left over, maybe we'll do a mental health thing.

[00:09:06] [SPEAKER_01] And we're always trying to impress upon employers like, yeah, that would be the case if we also weren't able to show that you're saving money in other areas by deploying a preventative mental health solution. So part of it is that we have to make the outcomes argument. But the other part is that we have to show these folks like this is the ROI of you spending this. You're saving this.

[00:09:30] [SPEAKER_00] Totally. Yeah. And what is the ROI? You know, what are the cost factors? Is it engagement, productivity? Is it meds? Like, what is it?

[00:09:41] [SPEAKER_01] So there's all sorts of different categories of savings that are associated with deploying like a mental health solution for I'm just talking about employees because there's a whole separate healthcare conversation around like claims reduction. And that's really interesting because there's these stats that like rolling out of preventative mental health solution can like reduce primary care visits because it's fascinating. Mental health touches your sleep and your diet and your social interactions and your med adherence.

[00:10:09] [SPEAKER_01] Like, so I'm putting that aside just for the sake of your question, staying focused on employees. And we bundle cost savings into three buckets. So we say one is claims, like I was just mentioning, like especially if you're like a self-insured employer or something like some groups really care a lot more about the claims reduction than others. But one is claims reduction. One is turnover costs.

[00:10:32] [SPEAKER_01] There are some stats in some of our decks about the percentage of people quitting related to excess stress and anxiety and depression about their work and in their workplace. And then the turnover costs associated with that. So in most cases, like if we can prevent one exit or a couple exits, if we can just postpone those people quitting just by a year, let's say we don't even prevent. We just postpone it a year.

[00:11:00] [SPEAKER_01] You've already saved more than you spent on cope notes. But let's say we prevent and postpone no exits. And the health care claims, for whatever reason, are exactly the same as they were before, which is not likely. But let's say we fail in those two areas. The other area that we like to focus on in terms of like savings for employers is the productivity. So cope notes has proven to increase focus, problem solving skills, coping skills, all sorts of things.

[00:11:27] [SPEAKER_01] And a lot of people are like presentees. They are at work, but they are not accomplishing work. And it's estimated that 28 work days are lost per year due to presenteeism. They're sitting at their computer, but they're stressed or they're anxious and they're not really there. And if we recover, we've done the math on this. We have like an ROI slide in our deck that shows like if we can recover just 10% of the lost productivity due to depression, anxiety and stress,

[00:11:55] [SPEAKER_01] which means, by the way, that your employees are still 90% as unproductive as they were before they used a tool that is proven to increase focus. So this means that we are basically still failing a very conservative estimate. You are still saving like 10 times what you're spending on cope notes. So it's a long way of saying claims, turnover savings and productivity savings are like the three categories that we impress upon employers for. But I'm sure there are more.

[00:12:21] [SPEAKER_00] That's awesome, man. No, it's good to know how you guys are measuring that. What are the texts? Like, do you have some texts that you could read off to us? Like, I'm curious now.

[00:12:29] [SPEAKER_01] Right on our homepage, there is a whole list of... Rattle off a few. Let's talk about them. There's a phone that shows a week's worth of cope notes text messages and it kind of cycles through. I love that you have that. I'll go there with you, but so you can start. So this one, just the first one that I see when I pull up the website, it says, when anxious, your body hunches over to protect the heart and lungs. Show your body that it's not in danger by standing up straight with your shoulders back.

[00:12:59] [SPEAKER_01] So that's part health education, like psychology fact, part exercise because you're like having a physical movement. Let's see some of these other ones on here.

[00:13:09] [SPEAKER_00] I got to give a second to cycle through them. You got a little pop-up here that says, curious, get seven days free. No strings attached. I'm getting in the system, brother.

[00:13:20] [SPEAKER_01] Do it. And then here's, I'll read one more. This one says, gratitude is a lot like a muscle. The more you exercise it, the stronger it gets. Tell us something big you're thankful for, then tell us something tiny. So we would categorize that as more of a journaling prompt where we're asking somebody, hey. And then you reply and you say it. Yeah. So like if you're the end user and you're receiving that message, you would actually type back in that thread and use it like a journaling prompt. You would respond. And it doesn't like.

[00:13:47] [SPEAKER_00] And it stays in my history. Like it stays in my text history. So I can go back and be like, oh. Yeah. Cool. I love that. Yeah, man. This is cool. And like the other thing I was thinking about the anxious one. When anxious, your body hunches over to protect the heart and lungs. It's also an awareness thing, right? Like you sort of like, oh, wow. I am hunched over right now.

[00:14:08] [SPEAKER_01] Yeah, I'm even doing it right now. I'm like, I'm not.

[00:14:11] [SPEAKER_00] Yeah.

[00:14:12] [SPEAKER_01] I want to signal to my body that I am safe.

[00:14:14] [SPEAKER_00] I'm pulling my shoulders back. Show your body that it's not in danger by standing up straight with your shoulders back. That is so simple. This thing is HSA and FSA eligible. Tell us about that. Yeah, that was cool.

[00:14:31] [SPEAKER_01] So I have an HSA account and I, when I first got one, I was like, you know, you can use it for like massages or vitamins and all this stuff. And I'm like, we have an evidence base. This is like published in medical journals showing that we have like proven health outcomes. How do we go through the process of like being able to accept HSA? Like I have an HSA debit card through my HSA plan and I can like swipe it on a cope note subscription. And it took a while.

[00:14:58] [SPEAKER_01] It's more of like a payment processing thing and you sort of have to prove out like, hey, this is a legitimate healthcare expenditure. And it was really cool to be able to tell people that because some people are like, they view their HSA as like, that's just for health stuff. And it's a little bit like free money to them because it wasn't in their bank account anyway. So it's cool. Like not only is cope notes exceedingly cost effective, like you get a full year for less than the price of one therapy session. So it's like extremely cost effective.

[00:15:27] [SPEAKER_01] But if you can just put it on your HSA card, I think a lot of people are like, oh, that's not even coming from my credit card anyway.

[00:15:34] [SPEAKER_00] Hey, I'm glad you mentioned the study. Talk to us about that. The size, the outcomes. It was essentially anxiety and depression, right? Yeah.

[00:15:43] [SPEAKER_01] So we've done two published research studies and then we've done a lot of case studies. And then we're doing financial studies right now that have not yet been published, but are probably going to be published next year about like the ROI for like claims data and stuff, which I'm super excited about publishing. But for right now, the one that we point to the most often is our study that's published in the Journal of Mental Health. And this, like we had done a qualitative study before that was published in the Journal of Medical Internet Research.

[00:16:11] [SPEAKER_01] And that was like our step one into like sort of the formal published research world. But then when we got like our quantitative evidence base and got that published in the Journal of Mental Health, that was when I think payers started going like, oh, okay, like these guys might be legit. So that study, we measured two groups. And this is so interesting to me. Like anyone who's interested in learning more, you can go to copenotes.com slash research. And there's like a research summary there where you can see. I see it.

[00:16:40] [SPEAKER_01] On graphs, like you can see decreased depression, decreased anxiety, decreased stress, increased coping skills, increased emotional intelligence. And what's cool about this, Saul, probably like the highlight that I always point to is we mapped outcomes for two separate groups. The first group is people who would identify as benefiting from support. So these are people with higher scores on the PHQ-9. They're experiencing depression and anxiety and stress. They're in like the moderate to severe symptom range.

[00:17:10] [SPEAKER_01] And we showed positive outcomes for them. But what's also just way potentially even cooler to me is that second group is we measured outcomes for people trying to stay mentally healthy. These are people in the low to moderate symptom range, people who had good scores on the PHQ-9, people who might not even identify as like, I don't even need therapy or anything. And with these people, we saw positive health outcomes.

[00:17:36] [SPEAKER_01] So what we learned in this study is like, you can take cope notes and give it to your entire employee base, your entire patient population and anticipate positive health outcomes, whether they're struggling or not.

[00:17:47] [SPEAKER_00] Love it. It's such an integral part of life. And that disconnect makes absolutely no sense to me. Like your mental health is your freaking body health. You know, it's like, come on, people. We got like it's 2026. But I'm glad you guys have the evidence, you know, like this evidence is so important. I love that. If you're not watching this, you probably want to know about this. We'll link it up in the show notes so you could see the study. It's a one pager. Pretty cool stuff.

[00:18:18] [SPEAKER_00] So, Johnny, what do you want to leave people with? You know, this is great. I think what you guys are doing is making a huge difference. I'm signed up now. By the way, is there a way for them if they're listening to this? We'll link it up in the show notes. But can they text to get signed up or is that not a thing?

[00:18:32] [SPEAKER_01] It's literally just go to copenotes.com. And that's where they do it. Just like I did with the pop up. Yep. A little thing will pop up that asks if you want to try it for free. And you saw how easy it is. You type in your phone number and press enter. Like this doesn't auto charge you. You don't put in your name or anything. It's like takes two seconds.

[00:18:49] [SPEAKER_00] Yeah, I'm in. I mean, I did it while we were chatting. So that simple. Whether you're an individual, but if you are a benefits leader or a broker or someone just wanting to help the people that you serve, certainly go to the website. We'll link it up in the show notes. As Johnny said, it's copenotes.com. Johnny, if people want to reach out to you, how can they get in touch with you?

[00:19:16] [SPEAKER_01] Yeah, I'm huge. Like I try to be as reachable as possible for this. This is like not a side quest for me. This is my full-time job. It has been for many years. So I tell people like, if you are curious about getting copenotes in the hands of like your clients or your daughter, like literally who, even yourself, you can email me directly johnny, J-O-H-N-N-Y at copenotes.com. And either I will answer your question or I will connect you with someone on my team who

[00:19:43] [SPEAKER_01] is more qualified to answer your question than I am.

[00:19:46] [SPEAKER_00] I love it. I love it, Johnny. I appreciate that invitation. Folks, do it. Take Johnny up for his invitation to connect. He's made it very simple. We'll have it in the show notes. If it's not you, then like Johnny said, forward this podcast to someone that you feel can use it because at the end of the day, we got to help each other out. That's how we get ahead. So I just want to, yeah.

[00:20:13] [SPEAKER_01] Oh, I want to mention real quick. So as someone who like spent most of my life living with diagnosed mental health conditions, if someone ever made a recommendation of a resource to me that they hadn't tried, I didn't trust them. I was like, you don't even know. How are you going to recommend? It's like, tell me to go to a restaurant that you've never been to. It's like, well, I don't trust that. So my encouragement to you is like, if you're listening and you are feeling fine, you don't have any kind of stress or anxiety or depression. First of all, congratulations. I'm jealous of you.

[00:20:42] [SPEAKER_01] That sounds wonderful. And second, try it anyway. Use it for a week because there will come a time, I am telling you, I've worked in behavioral health for long enough to know. There will come a time where your son or your wife or your coworker or your boss or your grandmother or somebody will be in need of a recommendation of a resource. And I'm telling you, you try this for seven days. You don't even have to pay us anything. Just try it.

[00:21:10] [SPEAKER_01] Try it so that when someone comes to you and mentions that they are not feeling well, you can say, I tried this resource that was pretty cool that you might like. And I'm telling you that the fact that you tried it for a week might be just convincing enough for that person to try it. And that could make a transformative difference in their life. So please, if not for your own sake, for the sake of someone who will need it more.

[00:21:33] [SPEAKER_00] That's awesome. No, I think that's such a great, great point, Johnny, because like, oh, have you used it? Oh, I haven't. But I heard it was cool. I actually did. I used it for seven days. Oh, you did. What'd you think? I like this, this and that. So, yeah, I think that's really great. I think that's a phenomenal recommendation. Check it out, guys. I just signed up. I'm always looking for ways to get better, be better and help those around me be better. So, Johnny, thank you for helping us be better, my friend. Really glad that we were able to do this.

[00:22:02] [SPEAKER_00] Thank you a ton for having me, dude.